title: Referral to palliative care in COPD and other chronic diseases: a population-based study.
abstract: OBJECTIVE
  To describe how patients with COPD, heart failure, dementia and cancer differ in frequency and timing of referral to palliative care services.
  
  
  METHODS
  We performed a population-based study with the Sentinel Network of General Practitioners in Belgium. Of 2405 registered deaths respectively 5%, 4% and 28% were identified as from COPD, heart failure or cancer and 14% were diagnosed with severe dementia. GPs reported use and timing of palliative care services and treatment goals in the final three months of life.
  
  
  RESULTS
  Patients with COPD (20%) were less likely than those with heart failure (34%), severe dementia (37%) or cancer (60%) to be referred to palliative care services (p < 0.001). The median days between referral and death was respectively 10, 12, 14 and 20. Patients with COPD who were not referred more often received treatment with a curative or life-prolonging goal and less often with a palliative or comfort goal than did the other patients who were not referred.
  
  
  CONCLUSIONS
  Patients with COPD are underserved in terms of palliative care compared to those with other chronic life-limiting diseases. Awareness of palliative care as an option for patients with COPD needs to increase in palliative care services, physicians and the general public.
authors.affiliation: End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Laarbeeklaan 103, 1090 Jette, Belgium. Electronic address: kim.beernaert@vub.ac.be.
authors.forename: Kim
authors.initials: K
authors.lastname: Beernaert
authors.forename: Joachim
authors.initials: J
authors.lastname: Cohen
authors.forename: Luc
authors.initials: L
authors.lastname: Deliens
authors.forename: Dirk
authors.initials: D
authors.lastname: Devroey
authors.forename: Katrien
authors.initials: K
authors.lastname: Vanthomme
authors.forename: Koen
authors.initials: K
authors.lastname: Pardon
authors.forename: Lieve
authors.initials: L
authors.lastname: Van den Block
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium; D002908:Chronic Disease; D003704:Dementia / Q000628:therapy; D005194:Family Practice / Q000458:organization & administration; D005260:Female; D006333:Heart Failure / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy; D010166:Palliative Care / Q000458:organization & administration / Q000706:statistics & numerical data*; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D012017:Referral and Consultation / Q000458:organization & administration / Q000706:statistics & numerical data*; D012111:Residence Characteristics; D012189:Retrospective Studies; D018571:Sentinel Surveillance; D013997:Time Factors; D055815:Young Adult
keywords: COPD; Dementia; Heart failure; Neoplasms; Palliative care; Referral